title: Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer.
abstract: BACKGROUND
  Shortened courses of radiation therapy have been shown to be similarly effective to whole-breast external-beam radiation therapy (WB-EBRT) in terms of local control. We sought to analyze, from a societal perspective, the cost-effectiveness of two radiation strategies for early-stage invasive breast cancer: single-dose intraoperative radiation therapy (IORT) and the standard 6-week course of WB-EBRT.
  
  
  METHODS
  We developed a Markov decision-analytic model to evaluate these treatment strategies in terms of life expectancy, quality-adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio over 10 years.
  
  
  RESULTS
  IORT single-dose intraoperative radiation therapy was the dominant, more cost-effective strategy, providing greater quality-adjusted life years at a decreased cost compared with 6-week WB-EBRT. The model was sensitive to health state utilities and recurrence rates, but not costs. IORT was either the preferred or dominant strategy across all sensitivity analyses. The two-way sensitivity analyses demonstrate the need to accurately determine utility values for the two forms of radiation treatment and to avoid indiscriminate use of IORT.
  
  
  CONCLUSIONS
  With less cost and greater QALYs than WB-EBRT, IORT is the more valuable strategy. IORT offers a unique example of new technology that is less costly than the current standard of care option but offers similar efficacy. Even when considering the capital investment for the equipment ($425 K, low when compared with the investments required for robotic surgery or high-dose-rate brachytherapy), which could be recouped after 3-4 years conservatively, these results support IORT as a change in practice for treating early-stage invasive breast cancer.
authors.affiliation: Department of Surgery, UCSF Comprehensive Cancer Center, San Francisco, CA, USA. michael.alvarado@ucsfmedctr.org
authors.forename: Michael D
authors.initials: MD
authors.lastname: Alvarado
authors.forename: Aron J
authors.initials: AJ
authors.lastname: Mohan
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Park
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Harrison
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Howe
authors.forename: Cristina
authors.initials: C
authors.lastname: Thorsen
authors.forename: Elissa M
authors.initials: EM
authors.lastname: Ozanne
mesh_terms: D001918:Brachytherapy / Q000191:economics* / Q000401:mortality; D001943:Breast Neoplasms / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008207:Lymphatic Metastasis; D008390:Markov Chains; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000191:economics* / Q000401:mortality; D015996:Survival Rate